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Hey, Robotic RP survivors, how long before back to work?

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Posted 4/25/2013 10:57 AM (GMT 0)
I had surgery on a Thursday...took the next week off and was back to work - desk job. Had cath in for five weeks... I was able to wear shorts to work which helped in the emptying of the cath.
Posted 4/25/2013 10:59 AM (GMT 0)

HighlanderCFH said...
*****Scheduled for robotic focal prostatectomy (preserving the apex) May 21, Dr. Menon, unless someone talks me into brachy before that*****

Steve, did the doctor say why they were going to remove all of the prostate except for the apex? I don't recall hearing of a partial prostatectomy very often in the past.

Chuck

Copying from my reply on another thread:  Focal therapy for prostate cancer is in its infancy. Prostate cancer, like breast and kidney cancer, is multifocal: that is there are many sites within the prostate that have individual, small cancers. A cancer has to be about 0.5 to1 cm in diameter before it can be seen on imaging studies, smaller cancers are missed.

Focal therapy is based upon two principles. First, that while treatment of visible lesions is important, treating the smaller lesions is not. Second, that treating just the visible cancer rather than the entire prostate will result in improved functional outcomes and a better quality of life.

The treatment that they are proposing, targeted surgery for prostate cancer is based upon data reported by London investigators (HIFU targeted therapy), but with important differences. This is a new approach, and has not been tried in men with prostate cancer. In this approach, they will remove two thirds of the prostate robotically, leaving the apex of the prostate with the surrounding capsule and nerve bundles intact. They have developed a technique whereby the prostate can be removed and real time biopsies obtained at the time of robotic surgery. This is conceptually different from ablating a cancer that cannot be detected clearly with imaging studies and leaving it in the body. They have tried the biopsy-during-sugery approach in over 150 patients at the time of complete prostatectomy, and found it to be safe and reliable. For patients undergoing targeted prostatectomy, samples from the cut end of the prostate will be examined for cancer. If there is cancer at the margin, the rest of the prostate will be removed. If there is no cancer, the tips will be left intact. The surgical principle is similar to that of breast lumpectomy, where the tumor is removed but not the entire breast.

What are the risks of this procedure? By leaving part of the prostate in the body, there will be residual prostate cells that will still make PSA. PSA values after focal HIFU have averaged about 2 ng/ml. I will need to get regular PSA testing after surgery. If the PSA levels are falling, no additional treatment will be recommended. However, if the values start to rise above the baseline at any point in time, they may recommend further investigations and treatment.

Second, because prostate cancer is multifocal, there is a risk that the remnant of the prostate may have a microscopic focus of cancer. Based upon Menon's tissue mapping studies of several thousand patients who have undergone robotic radical prostatectomy, they have determined that unrecognized cancer is present in the apex of the prostate in about 15% of men. In most of these men, the amount of cancer left behind is < 1mm, which they claim has a very low risk of spreading, even left untreated. The risk is even lower if a repeat biopsy shows no cancer.  For this reason, I will be required to have a biopsy of the remaining prostate at 6 months time. If cancer is detected, then I will be considering additional treatment… including surgical removal, radiation or targeted freezing.

Is targeted surgery any riskier than complete removal of the prostate? Menon claims there is no increased surgical risk for the patients. In a small minority (less than1%), the operation may be safer because of the greater ease in reconnecting the bladder.

Finally, the reason I'm considering this operation is the assumption that preserving the tip of the prostate will result in greater nerve preservation, and this in turn will result in better recovery of urinary control and sexual function. Menon submits that histological studies by others and by his group have shown that the greatest concentration of nerves is at the apex of the prostate. So, it's logical that preservation of the apex will result in increased nerve preservation.

While targeted prostatectomy has rarely been performed for patients with prostate cancer (Dr. Menon has only done a few), many surgeons have preserved the apex of the prostate in patients with bladder cancer. Such preservation has been associated with greater potency and continence (80-100% satisfactory erections and continence) than in patients who have undergone total removal of the prostate.

I will confess, after thinking about how long this recovery might take, I'm wondering about other options.

Posted 4/25/2013 11:02 AM (GMT 0)
I was back in about 2 and 1/2 weeks, but it was a bit too soon.
Posted 4/25/2013 1:14 PM (GMT 0)
I have a desk job and took two weeks off. Just went back to work on Monday....overall, pretty good, but I do get tired earlier in the evening than I used to before surgery.
Posted 4/25/2013 3:40 PM (GMT 0)
I work from home at a desk/bed/floor job (wherever I'm comfortable) so I am an exception to the rule.  I returned to work the day after I got home from the hospital.

Nonetheless, my experience would say that the first couple of days home were not productive for me.  I don't recover well from the anethesia so I was pretty darn tired and blurry-eyed for the first few days. After that passed I was good to go except for the sitting down part. I could sit in bed propped up by pillows, sort of reclined, without a problem. But, I found it difficult to sit up in a chair as my insides were so uncomfortable in that position. I would say that lasted for 2 weeks for me.

After 2 weeks I could pretty much do my desk job (sit all day) but would not consider doing any moderate lifting for at least 6 weeks (I'm almost to that point). If I had a job which required much walking I would give it another few days to a week longer. Looking back I would have probably done much more walking early on to help move recovery along faster.

Posted 4/25/2013 10:05 PM (GMT 0)
Had DaVinci at CoH, stayed overnight, came back in one week to get the catheter yanked out, went to work that afternoon. So 7 days from operation to work. My job is not physical so that helped. Also became continent pretty quickly so it wasn't much of an issue.

Only issue was that one of the holes they had poked in me to insert their tools was oozing and made a wet spot on my shirt the first day.

Posted 4/25/2013 11:08 PM (GMT 0)
I was back at work online the next week, but was on a FIVE pound lift limit for a couple of months, and was forbidden to drive for a month (because of sutures and the pain pills - in my state the pills I was taking qualify you for a DWI offense), so going to the office was not going to happen. My laptop bag weighs more than that limit.

My uro said 5-7 weeks when we were planning. Doing the FMLA paperwork is also insurance that you don't get laid off while you're out. I did the paperwork, but didn't claim the time as I had enough PTO to cover my real downtime. 

Because of incontinence issues and workplace logistics, I've never fully returned to my office workplace, and have had to stop travelling.

Other guys, same surgeon, back to work in a few weeks. It is unpredictable.

Posted 4/26/2013 10:37 AM (GMT 0)
Thanks, again, guys, for all the input!
Posted 4/26/2013 1:03 PM (GMT 0)
My job requires me to be able to lift 50lbs or more several times a day.  I was out for 8 weeks.  Work was normal when I went back but found out my fingertips were sensitive for mechanical work.
Posted 4/28/2013 5:11 AM (GMT 0)
Will vary with you your recovery, and your workplace.

I was doing some work (computer stuff) 4 days after surgery, with catheter, wearing sweatpants, moving slowly, and not too thrilled about it, but I basically have no backup and something came up despite having tried to clear the decks ahead of time. I also did a fair amount in bits and pieces from my home computer, which I was comfortable sitting at as soon as I got home from the hospital.

That was NOT anything like "a full day of work" - that was an hour or so of sorting out something with someone else's computer, alone, after hours (I was in no mood to discuss what I had had done or why with anyone more than my immediate boss at that point.)

It's also important to allow yourself enough time for walking a lot, if you possibly can. You might be able to manage that outside of work, you might not. You will also need to rest - abdominal surgery takes a lot out of you. Those appear to conflict, but they don't. I hope you are walking a lot now, it is supposed to help - and despite several months of putting in 3+ miles a day, it was a long time before I had full energy back post-surgical. I was able to get up to a mile (after starting out with a few yards up the hospital hallway, and then trips around the house when I got home for a few days) with catheter, very slowly and painfully, and 3 miles the night the catheter came out, though I.P. Freely was revising "Yellow River" in my Depends on that walk...

Picking things up is a much longer time. And I don't mean just heavy lifting - I had a 5 lb limit for 6 weeks, then 20 for another 6 weeks. That's not much at all. Tearing yourself open by picking things up too soon will not only then take an even longer time where you can't pick anything up to heal, it will also tick off your surgeon.

Bathroom arrangements can affect back to work time, especially if your leakage rate is less than ideal, doubly so if you are not out, loud and proud(?) about your condition. Unless you get very lucky, you'll be in there noticeably more often, and you'll have incontinence products to change/dispose of.
Posted 4/28/2013 8:02 AM (GMT 0)
Steve N,

Thanks for the explanation. When they do the partial prostate removal, do they still have to sever the urethra from the prostate base & reconnect it to the apex/urethra?

I don't know if this really gives much of an advantage over a full prostatectomy or not -- but, then again, I'm not a doctor, so there must be great hope for this type of surgery. My main fear would be that any currently unrecognizable cancer cells in the apex might grow large enough to show up down the road -- and you could be faced with yet another prostate operation.

I dunno, but it would seem like you might want to reconsider and choose between a full prostatectomy or brachy. If you went with a full prostate removal, your relative youth would probably make for a good recovery in the urination and sexual departments -- as always, much depends on the skill of the surgeon.

Maybe it would be a good idea to talk with more radiation oncologists for their opinions on seeding regarding your particular case -- and also other uro/surgeons regarding their thoughts on a focal prostatectomy.

Seems like you're doing all your homework, so whatever you end up doing will be the right thing for you.

Good luck again,
Chuck

Resident of Highland, Indiana just outside of Chicago, IL.
July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA Sept. 2011 was 5.7.
Local urologist DRE revealed significant BPH, but no lumps.
PCa Dx Aug. 2011 at age of 61.
Biopsy revealed adenocarcinoma in 3 of 20 cores (one 5%, two 20%). T2C.
Gleason score 3+3=6.
CT of abdomen, bone scan both negative.
DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
My surgeon was Dr. Matthew Tollefson, who I highly recommend.
Final pathology shows tumor confined to prostate.
5 lymph nodes, seminal vesicles, extraprostatic soft tissue all negative.
1.0 x 0.6 x 0.6 cm mass involving right posterior inferior,
right posterior apex & left mid posterior prostate.
Right posterior apex margin involved by tumor over a 0.2 cm length, doctor says this is insignificant.
Prostate 98.3 grams, tumor 2 grams. Prostate size 5.0 x 4.7 x 4.5 cm.
Abdominal drain removed the morning after surgery.
Catheter out in 7 days. No incontinence, occasional minor dripping.
Post-op exams 2/13/12, 9/10/12, PSA <0.1. PSA tests now annual.
Semi-firm erections now happening 14 months post-op & VERY slowly getting a bit stronger.
Posted 4/28/2013 10:46 AM (GMT 0)
Random, thanks for the explanation! So, what is the disposal of these pads? I presume they're not flushable, so do you roll 'em up and toss 'em in the trash like a diaper? I'm envisioning carrying a bag (small gym bag or soft brief (no pun intended) case to carry supplies? I do have a number of private facilities from which to choose, too. So I'll get some walking in and not fill up the trash can in any one location.

I haven't "hidden" what's going on, but I haven't made a general announcement either. Still deciding about how much to share, generally. But, I'm the telecom. admin. in our IT Department and, therefore, the go-to-guy for phone, voicemail, cell phone, wide-area network infrastructure and audio visual matters. I'll no doubt be on line some from home, too. (At least I think I'll be missed.)

I'll try getting back to walking. Having a little pain in my knee after playing some basketball last fall. Keep hoping that gets better so I can do some more exercise.

Highlander, yes they still cut through the urethra, just don't do it as low, so they have more to re-attach.

Also, they do biopsies of the cut edge, robotically, during surgery and get path report while I'm still out. So, if there's any sign of cancer, they take out the rest before sewing me up.

Yea, the thought of a follow up procedure isn't fun. But, the prospect of victory over incontinence and impotence in days/weeks/months rather than weeks/months/years is appealing. I'm still going back and forth on that and suppose I have up until the day of surgery to decide between full and focal.

Dr. Menon was one of the pioneers of robotic prostatectomies. So, to some extent, I am relying on his reputation in this area.

Thanks for the input. I really appreciate it.
Posted 4/28/2013 12:43 PM (GMT 0)
Incontinence pads/ pants don't flush, and will get smelly fast, so I bag mine. If you go to the store looking for pad disposal stuff, you'll find it is all decorated in feminine styles. I finally started using doggie disposal bags. They are usually black or brown, opaque, and cost less. Yes, the "fully" used ones are heavy. I had to take them out to the trash bin daily lest the bathroom trash bag get too heavy to carry.
Posted 4/28/2013 1:41 PM (GMT 0)
New York Times blue delivery bags are very useful for the disposal purpose.
Posted 4/29/2013 10:15 AM (GMT 0)
Thanks for the input on the bag ideas. As for pads, do you purchase locally or on-line? Any recommendations as to brand, or style or use?
Posted 4/29/2013 12:33 PM (GMT 0)
I purchase Depends and Tena Guards (they are different in bulk and absorbency, and have somewhat different use cases).

Both of those companies provide coupons, and both brands are at times on sale at Walgreens / CVS / Kroger, so I try to optimize the combination.

I looked at on-line sites, and beyond the delivery advantage (or the desire to not be seen checking out with them), on-line is generally more expensive than buying locally.

I'll look for my old posts on this, but you can search for "pants & pads". Early in my experience, I posted a lot about that.

Posted 4/29/2013 5:06 PM (GMT 0)
I put the pads in a zip lock sandwich bag to keep them clean until use. After changing a pad, I put the old pad rolled up into the sandwich bag an zipped it shut and tossed it in the garbage in the public restrooms. I kept extra pads at work and in all my car.
I went back to work in 3 weeks, could have gone back in 2 weeks but I am in sales and it was during our slowest months, summer.
Good luck

Bill from Florida
Posted 4/29/2013 10:11 PM (GMT 0)
Cath out on Day 12, work on Day 17. Fully padded, and started out slowly, 3-4 hours/day. Slowly increased the time and was at 40 hours/week after 2 weeks. Of course, I drive a desk. Spent lots of time in the bathroom changing pads and trying to pee.
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